Jacobson Adam S, Wenig Bruce M, Urken Mark L
Department of Otolaryngology-Head and Neck Surgery, Institute for Head, Neck, and Thyroid Cancer, Beth Israel Medical Center, New York, New York 10003, USA.
Thyroid. 2008 Dec;18(12):1325-8. doi: 10.1089/thy.2008.0280.
The term "collision tumor" refers to the coexistence of two histologically distinct malignant tumors within the same mass. Collision tumors involving the thyroid gland and/or neck region are especially uncommon, with most reported cases involving papillary thyroid carcinoma in coexistence with medullary thyroid carcinoma, follicular carcinoma, and metastatic disease, the latter including a rare occurrence of metastatic liposarcoma and thyroid papillary carcinoma. A collision tumor of papillary thyroid carcinoma and squamous cell carcinoma primary to the thyroid has also been reported.
We now report a collision tumor comprised of well-differentiated papillary thyroid carcinoma and squamous cell carcinoma that originated as a laryngeal primary tumor. Histologically, the thyroid mass is consisted of well-differentiated papillary thyroid carcinoma. The laryngeal mass consisted of in situ and invasive squamous cell carcinoma. Both cancers were extensively infiltrative into the soft tissues of the neck and paraglottic space where the histologically distinct tumor types approximated one another but were not admixed with each other. Additionally, cervical lymph nodes showed metastatic carcinoma, including independent cervical lymph nodes with metastatic squamous cell carcinoma only, cervical lymph nodes with metastatic papillary thyroid carcinoma only, and cervical lymph nodes with foci of both papillary thyroid carcinoma and squamous cell carcinoma.
As best we can determine this is the first publication of a collision tumor comprised of a well-differentiated papillary thyroid carcinoma and squamous cell carcinoma that originated as a laryngeal primary tumor. For any patient with a thyroid mass that appears to be in continuity with a laryngeal mass, more commonly one would find invasive thyroid cancer, but one must consider a collision tumor in the differential diagnosis.
“碰撞瘤”一词指的是在同一肿块内存在两种组织学上不同的恶性肿瘤。涉及甲状腺和/或颈部区域的碰撞瘤尤其罕见,大多数报道的病例是甲状腺乳头状癌与甲状腺髓样癌、滤泡癌及转移性疾病共存,后者包括罕见的转移性脂肪肉瘤与甲状腺乳头状癌共存的情况。也有报道过甲状腺原发性乳头状癌与鳞状细胞癌的碰撞瘤。
我们现报告一例由高分化甲状腺乳头状癌和鳞状细胞癌组成的碰撞瘤,其原发于喉部。组织学上,甲状腺肿块由高分化甲状腺乳头状癌构成。喉部肿块由原位及浸润性鳞状细胞癌构成。两种癌症均广泛浸润至颈部软组织和声门旁间隙,在该部位组织学上不同的肿瘤类型相互靠近但未相互混合。此外,颈部淋巴结显示有转移癌,包括仅伴有转移性鳞状细胞癌的独立颈部淋巴结、仅伴有转移性甲状腺乳头状癌的颈部淋巴结以及同时伴有甲状腺乳头状癌和鳞状细胞癌灶的颈部淋巴结。
据我们所能确定,这是首例关于由原发于喉部的高分化甲状腺乳头状癌和鳞状细胞癌组成的碰撞瘤的报道。对于任何甲状腺肿块与喉部肿块似乎相连的患者,更常见的情况是发现浸润性甲状腺癌,但在鉴别诊断时必须考虑碰撞瘤。